This is the 3704th article of Da Medical Care
Hyperuricemia and diabetes are both metabolic diseases, and both have a common basis for the onset of the disease - overnutrition, and both are clearly associated with insulin resistance, which are risk factors for cardiovascular disease. Since hyperuricemia is often associated with risk factors such as diet and alcohol intake, and these risk factors are also associated with the development of diabetes, it is difficult to clarify the causal relationship between the two.
Hyperuricemia refers to the normal dietary state, two times to detect fasting blood uric acid level > 420 μmol / L (7mg / dl), women > 360 μmol / L (6mg / dl); gout is a metabolic disease, because urate crystals are deposited in joints, soft tissues and kidneys, causing arthritis, skin lesions and kidney damage, etc., the two are different states of the same disease. Diabetes mellitus is a metabolic disease group mainly marked by hyperglycemia due to disorders of human glucose metabolism.
If you have both hyperuricemia and diabetes, treatment may fall into a dilemma: diabetes treatment requires more exercise, and active arthritis caused by hyperuricemia restricts excessive exercise; diabetes advocates a high-protein, low-calorie diet (ketogenic diet), hyperuricemia strictly controls meat intake, etc.; some hypoglycemic drugs may affect purine metabolism.
How to treat diabetes when hyperuricemia meets diabetes?
1. Adjust the diet structure and control the total calories of the diet
Promote a low-purine, low-fat, and low-salt diet.
1) Low carb diet
Controlling staple foods is beneficial for controlling blood sugar.
Effective in preventing and controlling gout, dietary fiber can increase insulin sensitivity. Regular consumption of fresh vegetables is a protective factor for the onset of gout.
(1) Lemons, cherries and olives are beneficial for gout patients.
(2) Watermelon, coconut, grapes, strawberries, plums and peaches can be eaten in moderation.
(3) The vast majority of melons, tubers, roots and most leafy vegetables are low-purine foods and are recommended to be eaten.
(4) It is not advisable to eat more plant foods with high purine content, such as shiitake mushrooms, grass mushrooms, asparagus, seaweed, kelp and grain germ.
(5) Reduce the intake of high fructose vegetables and fruits: some fruits (apples, bananas, figs, pears, oranges, longan, lychees, grapefruit, persimmons and pomegranates, etc.), vegetables (beets, lotus roots, horseshoes, etc.) and other fructose content is higher.
(6) Avoid alcohol consumption: Alcohol is one of the risk factors that lead to gout attacks. Alcohol consumption causes elevated uric acid through various routes and also affects the body's sensitivity to insulin. Studies have shown that beer and spirits increase the risk of gout attacks.
3) Drink plenty of water
The guidelines for the diagnosis and treatment of gout recommend that increasing the amount of water consumed can be used as one of the measures of non-pharmacological treatment for patients with gout. In the absence of contraindications such as kidney disease and heart failure, it is recommended that patients with gout drink water:
(1) The total daily water intake is 2 to 3 L.
(2) Drink water in batches, it is recommended to drink water three times in the morning, noon and evening to reach about 500ml.
(3) Drinking water should try to choose weak alkaline, small molecule water.
(4) Studies have shown that drinking lemonade (such as 1 to 2 fresh lemon slices added to 2 to 3 L of water) helps reduce uric acid.
(5) Soft drinks should be banned from both hyperuricemia and diabetes.
4) When gout patients eat animal foods, they should pay attention to the type, quantity and processing method
(1) Type: Avoid eating animal internal organs such as liver, kidney, heart, intestine, etc., and its purine content is higher than that of ordinary meat. Milk, eggs and an appropriate amount of non-mammalian meat (including chickens, ducks, geese and some freshwater fish) with low purine content can be selected, and the meat should be mainly lean meat.
(2) Quantity: It is generally believed that the daily meat intake of gout patients should not exceed 100g. (All meat needs to be fasted during the acute stage of gout)
(3) The processing method is very important. Cooking methods such as cured or smoked meats, fried, fried, brine or hot pot are not recommended. Fresh meat should be eaten as much as possible, and it is recommended to discard soup after boiling. Also, avoid condiments that are too much salt, sugar, and spices.
2. Choose drugs that have little effect on uric acid
1) Hypoglycemic drugs: insulin, sulfonylureas (glimepiride, gliclazide) have a certain impact on uric acid, the use of the above drugs to weigh.
2) Diuretics: thiazide diuretics (hydrochlorothiazide) and myelinic diuretics (furosemide) affect uric acid excretion and can induce elevated blood sugar, potassium-sparing diuretics (spironolactone, triamterene) have the effect of promoting uric acid excretion
3) Antihypertensive drugs: angiotensin-converting enzyme inhibitors (ACE Inhibitors) and Angiotensin II receptor blockers (ARB) have reduced insulin resistance, ARB has a hypouric acid-lowering effect, and hyperuricemia combined with diabetes mellitus is the preferred antihypertensive drug ARB;
4) Glucocorticoids: glucocorticoids increase weight, insulin resistance, and try to avoid use when gout attacks
3. Weight management
Adipose tissue produces and secretes more uric acid and increases insulin resistance. Body mass index is positively correlated with the incidence of gout. Abdominal obesity also increases the risk of gout. Weight loss reduces blood uric acid levels and is beneficial in reducing attacks of gout.
4. Exercise regularly and in moderation
Low-intensity aerobic exercise can reduce the incidence of gout, while moderate to high-intensity exercise may reduce uric acid excretion and increase blood uric acid levels, which in turn increases the incidence of gout. Appropriate exercise can be used as one of the non-pharmacological treatments.
Principles of movement
1) Patients with hyperuricemia are recommended to exercise regularly.
2) The exercise of patients with gout should start from low intensity and gradually transition to moderate intensity to avoid strenuous exercise. The acute stage of gout is mainly rest, interrupting exercise, which is conducive to the resolution of inflammation.
3) The number of exercises should be 4 to 5 times a week, each time 0.5 to 1 hour. You can choose jogging, tai chi and other methods.
4) During or after exercise, drinking water should be appropriate to promote uric acid excretion. However, it should be avoided to drink water quickly and in large quantities so as not to increase the burden on the body.
5) Patients with cardiovascular and pulmonary underlying diseases should moderately reduce the intensity of exercise and shorten the exercise time.
bibliography
[1] Huang Yefei, Yang Kehu, Chen Shuhong, et al. Practical guidelines for patients with hyperuricemia/gout[J].Chinese Journal of Internal Medicine,2020,59(7):519-527.
[2] Rheumatology Branch of Chinese Medical Association.2016 Chinese Gout Diagnosis and Treatment Guidelines[J].Chinese Journal of Internal Medicine, 2016,55 (22):892-899.
Author: Huangpu Branch of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
Qiu Wei, deputy director of the nursing department, is in charge of nurses
Department of Endocrinology An Zengmei Chief Physician